AdvancingShort-TermPrescribingforDentalPatients
Understand…1. Prescribingpatternsforacutedentalpain2. Evidence-basedrecommendationsfor
dentalprescribing3. Oregonprescribingguidelinesfordentists4. Initiativestoreducedentalopioid
prescribing
GaryW.Allen,DMD,MSVicePresidentofDentalServicesAdvantageDentalgarya@advantagedental.com
GaryW.Allen,DMD,MS
Ihavenothingtodiscloserelevanttothisdiscussion
OpioidPrescriptionsbyAgeandPhysicianSpecialty
JAMA2011,CharacteristicsofOpioidPrescriptionsin2009
DentistOpioidPrescribingPractices
• 85%oralsurgeonsalmostalwaysprescribeopioidanalgesics
• AverageRx=20tabsprnpain(range10– 40)• 24%prescribemorethanwouldgenerallybenecessary
JournalofOralandMaxillofacialSurgery,September2013
• 2010SurveyWestVirginiadentists:36%expecttheirpatientstohaveleftoverdrugs
JADA 2011,Preventionofprescriptionopioidabuse:Theroleofthedentist
Unusedopioidanalgesicsanddrugdisposalfollowingoutpatientdentalsurgery:Arandomizedcontrolledtrial
• 79patientshadwisdomteethremoved• 94%receivedopioidprescription• Averageprescription=28opioidpills• After24hrs painscale=5• After2dayspainscale=3• After3weeks,averagepillsremaining=15• ExtrapolatetoU.S.population:100millionunusedopioidpills
UniversityofPennsylvaniaPerelmanSchoolofMedicineDrugandAlcoholDependence,Sep16,2016
Providinginformationaboutdrugdisposalprogramsledto22percentincreaseinnumberofpatientswhodisposedofunusedmedication
• Establishedprescribingbehaviors• Prescribingforthemostsevereoutcome
• Patientexpectationsanddemands• UnawareordisregardoftheevidenceforNSAID/APAPincombination
JADA147(7)July2016
InitiativestoReduceOpioidAbuse
• OregonHealthAuthority&CCOs– Develop&communicateguidelines– Opioidprescribingreports&monitoring
• National&StatePolicies&Legislatures– Prescribinglimits– PDMPregistration(OregonHB4143)
• ProfessionalOrganizations
OregonOpioidPrescribingGuidelinesTaskForceDentalSubgroupOct12,2016
CurrentIssueADAadoptsinterimopioidspolicyMarch26,2018
Intheinterimpolicy,theAssociationsaysitsupportsthefollowing:• Mandatorycontinuingeducationonprescribingopioids• Prescribinglimitsonopioiddosageanddurationofnomore
thansevendaysforthetreatmentofacutepain• Dentistsregisteringwithandutilizingprescriptiondrug
monitoringprograms
• ProvidersshouldprescribeNSAIDsasfirst-lineanalgesictherapy• Whenindicatedforacutebreakthroughpain,considershort-actingopioidanalgesics
(startwithlowesteffectivedoseandtheshortestduration)• Ifsuspicionofpatientdrugmisuse,theOMSshouldaccessthePDMP• Limittheprescriptionsofopioidanalgesicstopatientstakingbenzodiazepinesand/or
otheropioids
2017WhitePaper
Modern HealthcareTheleaderinhealthcarebusinessnews,research&data
Aetnatargetsdentist'superprescribers'inlatestopioidinitiativeByShelbyLivingston | May18,2017
Usingclaimsdata,Aetnapinpointeddentistsandoralsurgeonswhoprescribedagreaterthanseven-daysupplyofopioidsatleastfourtimesoveratwo-yearperiod.Earlierthisyear,Aetnasentpersonalletterstothe480dentistsand249oralandmaxillofacialsurgeonswhofitthebillandwarnedthemtheyareinthetop1%ofhighopioidprescribersamongtheirpeers.Aetnaalsosentprescribingguidelinestohelpthose"superprescribers"rightthecourse.
LawLimitingOpioidPrescriptionsSignedinWestVirginiaWestVirginia'sgovernorhassignedlegislationtolimitpainkillerprescriptionsthatdoctorscanprescribeforacutepain.March28,2018,at8:37a.m.
Themeasurehaseventightercontrolsforopioidprescriptionsissuedatemergencyroomsandurgentcarefacilities— afour-daysupply.
ü Dentistsandoptometristswillberestrictedtoprescribingathree-daysupplyofpainpills.
BestDrugsforDentalPainForgetaboutVicodin,Percocet,andotherpotentiallydangerous,addictiveopioids.Over-the-counterpainkillersmayworkbetter.ByTeresaCarrJanuary24,2017
Tofindanauthorizedmedicationtake-backprogramnearyou,gotoDisposeMyMeds.orgorDEAdiversion.usdoj.gov andsearchfor"drugdisposal.”OrcalltheDEA’sRegistrationCallCenterat800-882-9539.
Health Care
Countless Opioid Pills Unused by Dental-Surgery Patients Sept. 27, 2016
CurrentIssueNovember30,2017
Dentiststressesprescribereducation,sharespersonalstoryduringSenateopioidshearing
Accidentalactivist:lifechangesleaddentisttospeakonopioidharmsMarch26,2018
